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Background
Millions of people worldwide are affected by peripheral arterial disease. Imaging evaluation is important for prompt diagnosis, procedural planning, and endovascular treatment. Ultrasound is often the initial imaging evaluation of choice. Ultrasound is a practical and convenient imaging modality with unique functions that provide a comprehensive evaluation of the lower extremity arterial system. Benefits of ultrasound include lack of radiation and the availability of grayscale, color Doppler, and pulsed wave Doppler imaging. These features provide both anatomic and physiologic information. The purpose of this exhibit is to provide an overview of the clinical use of ultrasound to diagnose, plan management, and follow up for lower extremity peripheral arterial disease.

Educational Goals / Teaching Points
Ultrasound and it's different techniques are a powerful tool to diagnose and evaluate peripheral arterial disease. Techniques include gray scale, color Doppler, pulsed wave Doppler, and intravascular ultrasound. Pulsed wave and color Doppler ultrasound can be used to evaluate blood flow characteristics, waveforms, and velocity. Grayscale ultrasound can be used to characterize diameter changes and localize stenoses and occlusions. Intravascular ultrasound can be used to characterize vessel cross sectional area and mural irregularities. Ultrasound findings can be used to guide treatment planning and interventional and clinical management. Ultrasound can be used post procedurally to evaluate response to treatment.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomy and pathophysiology include lower extremity arterial anatomy and collateral circulation, arterial wall anatomy, and atherosclerosis overview. Imaging include non-invasive imaging options for arterial disease evaluation, indications for peripheral arterial US examination, grayscale ultrasound and technique, color Doppler and technique, and pulsed wave Doppler and technique. Clinical correlations include characterizing stenoses, and blood flow velocity and correlation to stenosis. Limitations include calcified vessels, doppler angle, and tandem stenoses.

Conclusion
Early and accurate diagnosis of peripheral arterial disease is important for management and treatment planning. Ultrasound is a commonly utilized initial imaging evaluation. Ultrasound provides anatomic and physiologic information about anatomy and condition of the lower extremity peripheral arteries. An extensive understanding of ultrasound for lower extremity peripheral arterial disease is essential for radiology trainees and practicing radiologists.